Objective To evaluate the surgical outcomes of neoadjuvant chemoimmunotherapy for sleeve lobectomy. Methods The clinical data of patients diagnosed as non-small-cell-lung-cancer (NSCLC) and evaluated to undergo sleeve lobectomy surgery at TianJin Chest Hospital were retrospectively analyzed. Patients were divided into two groups: a neoadjuvant treatment group and a surgery alone group. The clinical characteristics, perioperative parameters, and postoperative outcomes of two groups were compared. Results Finally 22 patients were collected, including 19 males and 3 females with a median age of 63 years. There were 7 patients in the neoadjuvant treatment group, and 15 patients in the surgery alone group. There was no statistical difference in surgical time, intraoperative bleeding, lymph node dissection, postoperative catheterization time, and postoperative drainage volume between the two groups (P>0.05). In the neoadjuvant treatment group, 1 patient had a second thoracotomy exploration for hemostasis due to bronchial artery bleeding, 2 patients had wound infection, 1 patient had immune-associated pneumonia before surgery, and 1 patient had immune-associated pneumonia before postoperative adjuvant therapy. In the the neoadjuvant treatment group, 1/7 (14.3%) patients had a pathological complete response, and 3/7 (42.9%) patients achieved a major pathological response. Conclusion The surgical difficulty and post-surgical complication rate of sleeve lobectomy with neoadjuvant chemoimmunotherapy are higher than those of surgery alone but also offer appropriate oncological outcomes. Overall, neoadjuvant chemo-immunotherapy sleeve lobectomy can be considered as a treatment option for patients with locally advanced lung cancer.
ObjectiveTo investigate the clinical value of artificial intelligence (AI)-assisted chest computed tomography (CT) in the diagnosis of peripheral lung shadow. MethodsThe CT image data of 810 patients with peripheral pulmonary shadow treated by thoracic surgery in Tianjin Chest Hospital Affiliated to Tianjin University from January 2018 to July 2019 were retrospectively analyzed using AI-assisted chest CT imaging diagnosis system. There were 339 males and 471 females with a median age of 63 years. The malignant probability of preoperative AI-assisted diagnosis of peripheral pulmonary shadow was compared with the results of postoperative pathology. ResultsThe pathological diagnosis of 810 patients with peripheral pulmonary shadow was lung cancer in 627 (77.4%) patients, precancerous lesion in 30 (3.7%) patients and benign lesion in 153 (18.9%) patients. The median probability of malignant AI diagnosis before operation was 86.0% (lung cancer), 90.0% (precancerous lesion) and 37.0% (benign lesion), respectively. According to the analysis of receiver operating characteristic (ROC) curve of AI malignant probability distribution in this group of patients, the area under the ROC curve was 0.882. The critical value of malignant probability for diagnosis of lung cancer was 75.0% with a sensitivity of 0.856 and specificity of 0.814. A total of 571 patients were diagnosed with AI malignancy probability≥75.0%, among whom 537 patients were pathologically diagnosed as lung cancer with a positive predictive value of 94.0% (537/571). ConclusionThe AI-assisted chest CT diagnosis system has a high accuracy in the diagnosis of peripheral lung cancer with malignant probability≥75.0% as the diagnostic threshold.
ObjectiveTo evaluate the efficacy and safety of programmed cell death receptor 1 (PD-1) inhibitor combined with chemotherapy in the preoperative neoadjuvant treatment of stage Ⅲ non-small cell lung cancer (NSCLC).MethodsThe clinical data of 68 patients with stage Ⅲ NSCLC who underwent preoperative neoadjuvant treatment in our hospital from June 2019 to October 2020 were analyzed and divided into two groups according to a random number table. There were 34 patients in the control group including 19 males and 15 females with an average age of 59.41±4.77 years. In the observation group, there were 34 patients including 21 males and 13 females with an average age of 61.15±6.24 years. The patients in the control group were treated with albumin-bound paclitaxel and cisplatin for injection, and the patients in the observation group were treated with carrelizumab on the basis of the control group, and both groups received 2 cycles of preoperative neoadjuvant therapy. We compared the clinical efficacy of imaging, T lymphocyte subsets, drug side effects, surgical resection rate, major pathological remission (MPR), complete pathological remission (pCR) and postoperative complications of the two groups of patients, and analyzed the influencing factors for MPR.ResultsThe objective response rate (ORR) of imaging in the observation group (70.6%) was higher than that in the control group (38.2%, P<0.05). The positive rate of CD3+ cells, the positive rate of CD4+ cells, the positive rate of CD8+ cells and the ratio of CD4+/CD8+ cells in the observation group after treatment were higher than those in the control group (P<0.05). The drug toxicity of the observation group was higher than that of the control group in the reactive cutaneouscapillary endothelial proliferation (RCCEP)/rash, abnormal thyroid function, and abnormal myocardial enzymes (P<0.05). The MPR (66.7%) and pCR (51.9%) of the surgical observation group were higher than those of the surgical control group (MPR: 19.2%, pCR: 7.7%, P<0.05). There was no statistical difference in surgical resection rate and postoperative complications between the two groups (P>0.05). Univariate analysis showed that ECOG score, pathological type, neoadjuvant treatment plan and surgical resection were related to MPR (P<0.05). The results of binary logistic regression analysis showed that Eastern Cooperative Oncology Group (ECOG) score and neoadjuvant treatment plan were independent risk factors for MPR (P<0.05).ConclusionThe clinical efficacy of PD-1 inhibitor combined with chemotherapy in the preoperative neoadjuvant treatment of stage Ⅲ NSCLC patients is definite, and it can significantly improve the patients' MPR, pCR and cellular immune function, but the side effects caused by immunotherapy drugs need to be concerned.
ObjectiveTo compare the 5-year survival rates between two different follow-up patterns of postoperative stage Ⅰ-ⅢA non-small cell lung cancer (NSCLC) patients.MethodsPathological stage Ⅰ-ⅢA NSCLC 11 958 patients who underwent surgical resection and received follow-up within 6 months after initial diagnosis through telephone follow-up system were included in nine hospitals from July 2014 to July 2020. The patients were divided into two groups including a proactive follow-up group (n=3 825) and a passive follow-up group (n=8133) according to the way of following-up. There were 6 939 males and 5 019 females aged 59.8±9.5 years. The Kaplan-Meier and Cox proportional hazards regression model were used.ResultsThe median follow-up frequency was 8.0 times in the proactive follow-up group and 7.0 times in the passive follow-up group. The median call duration was 3.77 minutes in the proactive follow-up group and 3.58 minutes in the passive follow-up group. The 5-year survival rate was 81.8% and 74.2% (HR=0.60, 95CI 0.53-0.67, P<0.001) in the proactive follow-up group and the passive follow-up group, respectively. Multivariate analysis showed that follow-up pattern, age, gender and operation mode were independent prognostic factors, and the results were consistent in all subgroups stratified by clinical stages.ConclusionThe proactive follow-up leads to better overall survival for resected stage Ⅰ-ⅢA NSCLC patients, especially in the stage ⅢA.